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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93501669

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Arthur LeRoyCoombs Sex Male

Date of Birth November 16, 1906 Place of Birth Virginia EastCounty of Annapolis

Name of Father Albridge Coombs MAIDEN NAME of Mother Alice Sarah Cam

Residence of Father when child was born Virginia East Present address of Father Waltham, Massachusetts

Occupation of Father at Birth of child Iceman Place of birth of Father Virginia East

Race white Name and present address of Physician in attendance at birth Dr. Archibald

Signature of Applicant Alice Sarah Coombs Address of Applicant Halifax Date 13 March 1926

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Arthur LeRoyCoombs

Born at Virginia East in the County of Annapolis

That Arthur LeRoyCoombs Whose Birth is sought to be registered was

born at Virginia East Annapolis County on November 16, 1906

My knowledge of the fact and date of such Birth is based on the following Circumstances:

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